Provider Demographics
NPI:1326755539
Name:WATSON, ERICA ELENA (DHSC, CNC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ELENA
Last Name:WATSON
Suffix:
Gender:F
Credentials:DHSC, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1628
Mailing Address - Country:US
Mailing Address - Phone:860-772-8734
Mailing Address - Fax:
Practice Address - Street 1:12 ROOSEVELT AVE STE 15
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2841
Practice Address - Country:US
Practice Address - Phone:860-572-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1220895967133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education